Polycystic Ovarian Syndrome

How to reverse its underlying condition: Insulin Resistance.

This is not about fad diets, magic pills or fantasy claims to transform the way you look and feel overnight. It is about accurate scientific information that can help you to effectively change the way your body responds to food and help reverse PCOS.

Scientists at the National Institutes of Health, Stanford University and other research centers have clearly identified the existence and effects of Insulin Resistance, a biochemical condition that causes excessive weight gain and PCOS, which is also known as polycystic ovaries. If you are among the 65% of the overweight population with Insulin Resistance, your ability to reverse your PCOS and lose weight may not have been within your control - until now.

This breakthrough in understanding the body’s biochemistry remains relatively unknown, even though Insulin Resistance has reached epidemic proportions. Your doctor may not have explained the crucial link between Insulin Resistance and PCOS. You need to understand this link in order to reverse your condition.

PCOS is a hormonal imbalance linked to the way the body processes insulin after it has been produced by the pancreas to regulate blood sugar (glucose).

The underlying cause of PCOS, Insulin Resistance, has many factors that contribute to its presence in the body. In essence, our environment and lifestyles have evolved too rapidly for our bodies to keep pace. We are still genetically “wired” to thrive on the entrenched habits of our ancestors, who consumed different, nutrient-rich foods, a diet low in carbohydrates and who sustained greater levels of movement and exercise. Some people may also have a genetic predisposition to Insulin Resistance, while others develop the condition through high stress and unhealthy lifestyles.

INSULIN RESISTANCE NEGATIVELY AFFECTS GLUCOSE AND INSULIN LEVELS

Over time, the above factors have damaged the complex ability of the body’s cells to properly utilize insulin to convert glucose to energy. This process creates Insulin Resistance, which causes PCOS in two distinct ways.

First, Insulin Resistance vastly reduces the number of insulin receptor sites or doorways on the walls of your cells. The average healthy person has some 20,000 receptor sites per cell, while the average overweight individual with PCOS can have as few as 5,000. If you have too few receptor sites, glucose bounces off the cell wall, instead of passing through the insulin door to be burned as energy. With the cell door almost closed to it, glucose remains in the blood stream, causing elevated levels of blood sugar, which are sent to the liver. Once there, the sugar is converted into fat and stored via the blood stream throughout the body. This process can lead to weight gain and obesity, key factors in creating PCOS.

The second way that Insulin Resistance causes PCOS is by raising insulin levels in the blood stream. Unhealthy lifestyles and genetic conditions cause the pancreas to overproduce insulin. The cell is, in turn, overwhelmed by this excess insulin and protects itself by reducing the number of its insulin receptor sites. This process leaves too few sites for insulin to carry out its normal function, which is to attach itself to the cell wall and act as a key in a lock allowing glucose to pass through the cell wall and be converted into energy. The vastly-reduced number of receptor sites in Insulin Resistant people causes an excess of insulin “rejected” by the cell to free-float in the blood stream, creating unbalanced hormone levels in PCOS sufferers.

Excess insulin stimulates the ovaries to produce large amounts of the male hormone testosterone, which may prevent the ovaries from releasing an egg each month, thus causing infertility. High levels of insulin also increase the conversion of androgens (male hormones) to estrogens (female hormones), upsetting a delicate balance between the two and having a direct effect on weight gain and the formation of cystic follicles or cysts in the ovary.

Since your body isn’t converting food to energy properly, it demands even more food. As these cravings increase, so does weight gain.

As Insulin Resistance and weight gain continue to increase, your body further loses its ability to process food correctly, causing even more weight gain.

Eating binges occur as a result of Insulin Resistance. More insulin enters the blood stream, laying the foundation for excessive weight gain and obesity, which can cause PCOS

INSULIN RESISTANCE NEGATIVELY AFFECTS GLUCOSE AND INSULIN LEVELS

Over time, the above factors have damaged the complex ability of the body’s cells to properly utilize insulin to convert glucose to energy. This process creates Insulin Resistance, which causes PCOS in two distinct ways.

First, Insulin Resistance vastly reduces the number of insulin receptor sites or doorways on the walls of your cells. The average healthy person has some 20,000 receptor sites per cell, while the average overweight individual with PCOS can have as few as 5,000. If you have too few receptor sites, glucose bounces off the cell wall, instead of passing through the insulin door to be burned as energy. With the cell door almost closed to it, glucose remains in the blood stream, causing elevated levels of blood sugar, which are sent to the liver. Once there, the sugar is converted into fat and stored via the blood stream throughout the body. This process can lead to weight gain and obesity, key factors in creating PCOS, which is also referred to as Polycystic Ovarian Disease or PCOD.

The second way that Insulin Resistance causes PCOS is by raising insulin levels in the blood stream. Unhealthy lifestyles and genetic conditions cause the pancreas to overproduce insulin. The cell is, in turn, overwhelmed by this excess insulin and protects itself by reducing the number of its insulin receptor sites. This process leaves too few sites for insulin to carry out its normal function, which is to attach itself to the cell wall and act as a key in a lock allowing glucose to pass through the cell wall and be converted into energy. The vastly-reduced number of receptor sites in Insulin Resistant people causes an excess of insulin “rejected” by the cell to free-float in the blood stream, creating unbalanced hormone levels in PCOS sufferers.

Excess insulin stimulates the ovaries to produce large amounts of the male hormone testosterone, which may prevent the ovaries from releasing an egg each month, thus causing infertility. High levels of insulin also increase the conversion of androgens (male hormones) to estrogens (female hormones), upsetting a delicate balance between the two and having a direct effect on weight gain and the formation of cystic follicles or ovarian cysts.

Because the symptoms vary so widely and not all women display all the symptoms, doctors very often misdiagnose PCOS. This became an issue of critical concern after a study in 2000 found that women suffering from PCOS have a higher risk of coronary heart disease.

Researchers found a link between PCOS and other metabolic conditions such as obesity, high blood pressure and high levels of LDL “bad” cholesterol, all of which are risk factors for coronary heart disease.

Studies have also shown an increased link between PCOS and atherosclerosis, which occurs when fatty deposits called plague cling to the interior walls of the arteries, leading to blockages that can cause heart attacks or stroke. Not only do PCOS sufferers have higher rates of plaque buildup but those over 45 have thicker deposits of plaque.

Another report indicated that up to 40% of women with PCOS have either impaired glucose tolerance or Type 2 Diabetes by the age of 40.

All these findings substantially raise the bar on the seriousness of PCOS, making it even more important that doctors correctly diagnose the condition and instruct their patients about its cause – Insulin Resistance.

At present, there are no pharmaceutical drugs that can heal PCOS. Even the removal of the ovaries will not completely eliminate this disorder. A complete system of elements is needed to treat this condition’s underlying cause, Insulin Resistance.

Metformin (Glucophage) is a pharmaceutical drug often prescribed for women with PCOS (Polycystic Ovarian Syndrome). It is an insulin-sensitizing biguanide commonly used to treat elevated blood glucose levels in people with Type 2 Diabetes. Metformin is used as an off-label prescription for PCOS. This means that it was originally used only for individuals with Type 2 Diabetes but is now prescribed for PCOS patients because it has similar actions in both groups.

Metformin – Side Effects

Many women prescribed Metformin must discontinue its use due to the gastrointestinal side effects. The most commonly reported adverse effects include diarrhea, gas and bloating, abdominal discomfort, nausea, and vomiting (1, 6). Another consideration of Metformin therapy is its effect on B12 absorption. Ten - 30% of people receiving long term Metformin therapy develop B12 malabsorption, which could potentially lead to anemia.

It has also been shown that treatment with Metformin may increase homocysteine levels (amino acids found in the blood), which is a risk factor for atherosclerosis or fatty deposits in blood vessels (7).

The contraindications in using Metformin include liver failure, alcoholism, compromised renal function, hypoxic conditions and moderate to severe infections. These conditions predispose women to having lactic acidosis, which is a life-threatening complication and carries a mortality rate of 30% - 50% (1).

The Insulite PCOS System is the first scientifically-formulated plan to address the underlying cause of PCOS and reverse the symptoms. By raising the number of insulin receptor sites on your cells, the Insulite PCOS System increases your body's capacity to allow glucose to enter your cells, reducing overall insulin load -- the major contributing factor to PCOS . This comprehensive system supports your body's ability to balance glucose and insulin levels, thus helping you lose weight . The Insulite PCOS System also reverses the symptoms of PCOS by decreasing estrogen and androgen hormones and stimulating SHBG (sex hormone-binding globulin) to regulate ovulation. It also inhibits 5 alpha-reductase, an enzyme of the male hormone, testosterone. This reduces DHT (dihydrotestosterone) which is responsible for the development of most secondary male sex characteristics.

Symptoms of the disorder may also include hirsutism (abnormal growth of hair), thinning hair, acne, weight gain, depression and anxiety.

In the study, published in the journal Fertility and Sterility in February 2005, physicians at the University of California at San Diego theorized that PCOS is connected with a higher risk of developing non-alcoholic fatty liver disease, or NAFLD. This is an umbrella term used to describe a range of liver diseases, from benign to potentially fatal, which are characterized by the accumulation of fat in the liver. This increase in fatty liver risk can be caused by different things, such as Insulin Resistance-related disorders like Type 2 Diabetes, weight gain, poor diet or associated illnesses like tuberculosis. A more damaging kind of fatty liver disease is known as non-alcoholic steatohepatitis (NASH), which is diagnosed when accumulated fat causes liver inflammation, resulting in permanent damage to the organ.

"We hypothesized that women with PCOS would demonstrate a high incidence of NAFLD because of the link to Insulin Resistance," explained Walter Schwimmer, Assistant Clinical Professor of Pediatrics at Kaiser Permanente Medical Center in Bellflower, California, and one of the study's lead researchers.

Insulin Resistance is a shared characteristic of both PCOS and NAFLD. "The data in the study, in fact, demonstrates that elevated ALT is more common in women with PCOS than in the general population of women of a similar age, race and body weight," he added.

Doctors look for levels of ALT as a sign of liver disease. ALT stands for alanine aminotransferase, an enzyme released by the liver into the blood stream when the liver is damaged.

For the study, researchers reviewed the records of 70 women who had been evaluated for infertility. Information was gathered on height, weight, blood pressure, hirsutism, liver enzyme levels, fasting glucose, fasting insulin and cholesterol.

Nearly a third of the women diagnosed as having PCOS had higher-than-normal levels of ALT, indicating the presence of liver disease. Additionally, levels of another liver enzyme, aspartate aminotransferase, or AST, were increased in 12% of the patients studied. All seven subjects with an elevated AST also had an elevated ALT.

Women with higher ALT levels also weighed significantly more, had a higher waist circumference, increased triglyceride levels and higher cholesterol. "There was a significant association between the presence of hirsutism and the finding of an abnormal ALT in women with PCOS," the study reported, adding that the link between fatty liver disease and hirsutism was "very unexpected."

"We determined that Insulin Resistance explains the high rate of elevated ALT in women with PCOS, and that these women with PCOS are at increased risk for NAFLD," said Professor Schwimmer.

But the investigators also cautioned that since liver biopsies weren't performed in the study, it was not possible to determine the true prevalence of NAFLD in the group of women.

In conclusion, the investigators recommended that women diagnosed with PCOS who also have higher ALT levels avoid alcohol and acetaminophen, both of which can be toxic to a diseased liver.

PCOS and Metabolic Syndrome (Syndrome X)

Sufferers of Polycystic Ovarian Syndrome (PCOS) are at greater risk of developing Metabolic Syndrome, a cluster of cardiovascular diseases, which raises the risk of a heart attack or stroke. It also increase the chances of developing Pre-Diabetes, a reversible condition, which if neglected, can become irreversible Type 2 Diabetes.

According to the American Heart Association, between 20-25% of the adult population of the United States suffer from the condition. That’s somewhere between 58 and 73 million men and women.

People suffering from this disorder, also known as Syndrome X, are four times more likely to have a heart attack or stroke than those free of the condition. And that’s only the beginning. Women with Metabolic Syndrome are also more prone to PCOS (Polycystic Ovarian Syndrome; also known as Polycystic Ovarian Disease), which causes the ovaries to secrete abnormally high levels of male hormones. This can cause a variety of symptoms, ranging from infertility and excessive facial and body hair growth to acne, menstrual irregularities and male pattern baldness.

The bad news doesn’t end there, either. PCOS sufferers with Metabolic Syndrome are also at greater risk of developing Gestational Diabetes and have higher rates of liver, breast and colon cancer. Males who have Metabolic Syndrome are at greater risk of developing prostate cancer.

Only in recent years has Metabolic Syndrome undergone extensive scientific investigation. The medical community has made a dramatic change in the way it views and treats this condition after a growing body of evidence pointed to Insulin Resistance as the underlying cause of Metabolic Syndrome.

Insulin Resistance is caused by unbalanced glucose and insulin levels resulting from too few insulin receptor sites on the cell’s surface. This vastly reduced number of sites prevents the efficient conversion of food into glucose or sugar for energy in the cell by barring entry through the cell wall. Instead, free-floating glucose remains in the blood stream where it causes elevated blood sugar levels. The sugar is sent to the liver where it is converted into fat and then stored throughout the body. The end result can be weight gain and obesity.

In addition, the imbalance in glucose and insulin levels has been proven to cause damage to the lining of the arteries, changes in the kidneys’ ability to remove salt and an increased risk of blood clot formation, all of which are key factors in developing Cardiovascular Disease, heart attacks and strokes.

Excess glucose also lays the foundation for Type 2 Diabetes by raising blood sugar to dangerous levels. It also sometimes prompts abnormal cell growth, implicating it as the cause of certain cancers as well as PCOS and Metabolic Syndrome.

At the present time, there is no single pill that will cure Metabolic Syndrome, just as there are no pharmaceutical drugs that will heal PCOS. But there are ways to address Insulin Resistance, the underlying cause of these conditions and PCOS symptoms. You must also combine neutraceuticals (vitamins, herbs and minerals that are disease specific), a realistic exercise program, nutritional guidance and a support system that will help you change unhealthy lifestyle choices if you wish to return to optimum health.

Polycystic Ovarian Syndrome (PCOS) and Metabolic Syndrome share Insulin Resistance-related obesity as an underlying cause. The Insulite PCOS System has been scientifically-designed to reverse Insulin Resistance in combination with a nutritious diet and regular exercise. It includes a formula targeted to slow the absorption of glucose into the blood stream, which reduces insulin response - a key factor in weight gain and the onset of PCOS and Metabolic Syndrome.

Ultrasound Study

Women had a pelvic ultrasound examination on the second or third day of their menstrual cycle and blood samples were taken to measure levels of reproductive hormones. A clinician, nurse and counselor or clinical psychologist took details of their medical and sexual histories in three separate sessions.

The researchers found that the prevalence of polycystic ovaries was no less than 80% in gay women, while 32% of heterosexual women had the disorder. Full-blown PCOS was discovered in 14% of the heterosexual women and 38% of the lesbians. The average prevalence amongst all 618 women, lesbian and heterosexual, was 52% for ovarian cysts and 24% for PCOS. This compares with European data showing that the incidence of polycystic ovaries in the general female population is 22% and 10-15% for PCOS, while 40% of all women who seek fertility treatment have either polycystic ovaries or PCOS.

Dr Agrawal said the high levels of the condition among gay women meant that "doctors should be on the lookout for its telltale signs among their lesbian patients in order to make sure that their wider health was not at risk."

Hyperandrogenism is caused by abnormally high concentrations of androgens (male steroid hormones in women). Symptoms can range from excess facial and body hair, to baldness, acne, deepening of the voice and loss of breast tissue.

SHBG (sex hormone binding globulin) is a protein that binds testosterone and other sex hormones. Women with PCOS may have normal concentrations of total testosterone, but their SHBG is lowered and therefore free testosterone concentrations are elevated, which results in symptoms related to hyperandrogenism.

Dr. Agrawal said: "When we compared lesbian and heterosexual women with PCOS, lesbian women had significantly higher androgens and lower SHBG compared with heterosexual women. We found a similar result in women with polycystic ovaries only. But in lesbian and heterosexual women with normal ovaries, the androgens and SHBG levels were similar.

"There are several challenges and gaps in the research and healthcare of homosexual people and this in itself calls for focus and funding of this aspect of medicine. In the past 20 years, only 0.1% of published articles were dedicated to the healthcare of homosexual individuals. Before 1990, homosexual people were invisible to healthcare research.

"Our study emphasizes the importance of treating these women in a non-judgmental and non-biased manner, so that clinicians may offer them appropriate health advice."

PCOS is the most common endocrine (hormonal) condition among women who menstruate and may affect up to 20% of women of reproductive age in America. The disorder is also known as polycystic ovaries, Sclerocystic Ovarian Disease, Stein-Leventhal Syndrome and Polycystic Ovarian Disease.

Researchers have long know that both Diabetes and being overweight raise the risk of developing Alzheimer’s and other types of dementia. A new study from the Joslin Diabetes Center suggests that the malfunctioning insulin receptors seen with Insulin Resistance may be a link between those disorders. “The brains of specially-bred lab mice show the same biological changes seen in Alzheimer’s Disease,” says researcher C. Ronald Kahn, M.D., one of the study’s authors. “We can say that based on this evidence, people with insulin resistance might be at risk for developing these kinds of brain changes.”

A growing body of evidence suggests that Insulin Resistance and glucose abnormalities may contribute to the pathophysiology (the physiology of abnormal states) and symptoms of depression, Alzheimer’s disease and other mental disorders.

“Insulin resistance is clearly present in Alzheimer's and may be linked to depression, which in some cases precedes Alzheimer's,” Dr. Natalie Rosgon of the International Psychogeriatric Association said in an interview. She theorizes that persistent, untreated Insulin Resistance among patients with depression leads to the neurodegeneration associated with Alzheimer's.

The evidence underlying the theory includes neuro-endocrine conditions described in both disorders and tests show that increased levels of glucose in the blood stream and decreased cerebral blood flow in specific areas of the brains of patients put them at risk for Alzheimer's disease, years before dementia occurs.

The exact interaction of these conditions is somewhat unclear – it’s part of a complex neurobiological jigsaw puzzle that scientists are still studying. But early data suggests that Alzheimer’s patients show improved memory after an infusion of insulin, which speaks to the role of glucose metabolism in the physiology of dementia.

Depression or mood swings also are common in women with PCOS. Although more research is needed to determine the exact causes of this link, there are studies that link depression to Diabetes. Therefore, in PCOS, depression may be related to Insulin Resistance. It also could be a result of the hormonal imbalances and the cosmetic symptoms of the condition, such as acne, hair loss and other symptoms of PCOS. Women with Diabetes, who have twice the risk of developing depression, showed improvement in depressive instances when they received education and treatment for Insulin Resistance.

Patients with depression and other affective disorders should be regularly screened for Insulin Resistance. While there has been a tendency in the medical community to view depression only as a mental illness, there is growing evidence that the imbalance of glucose and insulin in the blood stream plays a far more serious role than previously thought.

Studies have shown that a multi-faceted approach is necessary to address the symptoms of these syndromes – a single pharmaceutical or even a combination of them, will not eradicate or reverse these conditions. You must also combine nutraceuticals (vitamins, herbs and minerals that are disease specific), a realistic exercise program, nutritional guidance and a support system that will help you change unhealthy lifestyle choices.